Provider Demographics
NPI:1922403237
Name:JORDAN, LIZABETH LEIGH (PHD)
Entity Type:Individual
Prefix:
First Name:LIZABETH
Middle Name:LEIGH
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LEHIGH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1692
Mailing Address - Country:US
Mailing Address - Phone:847-425-6400
Mailing Address - Fax:847-599-3637
Practice Address - Street 1:2300 LEHIGH AVE STE 215
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1692
Practice Address - Country:US
Practice Address - Phone:847-425-6400
Practice Address - Fax:847-599-3637
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009351103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist